Oral steroids for asthma: An unequal risk

(BPT) - More than 25 million Americans live with asthma, but people across the country are affected differently. For example, people from Black and Hispanic communities are more likely to visit the hospital due to asthma symptoms and less likely to discuss an asthma action plan with their doctor. These hospital visits mean asthma may be uncontrolled for many people in these communities. And when asthma is uncontrolled, oral corticosteroids (OCS) are often used to manage flare-ups.

OCS, like prednisone or dexamethasone, are important fast-acting medicines that are often used to treat flare-ups by quickly reducing swelling in the airways that happen during an asthma attack. These common medicines, which are given as pills, are critical for people living with asthma.

However, OCS use also has serious short- and long-term health risks such as high blood sugar, bone thinning or infections. Because of this, they should only be used for daily control of asthma as a last resort. In fact, requiring OCS more than twice a year can be a sign that the condition is uncontrolled and that a new asthma management plan is needed. Steroids can also be given by an IV drip or an injection in the hospital. If someone is treated with steroids this way, they should let their other doctors know.

“Oral corticosteroids for the control of asthma symptoms and exacerbations have been a mainstay of treatment for over four decades, but carry serious health risks if overused,” said Eugene Bleecker, MD, Co-Chief, Division of Genetics, Genomics and Precision Medicine, Department of Medicine, University of Arizona Health Sciences. “Across the country we have seen oral steroids be overused, with many people who suffer from asthma receiving more than two bursts per year. Unfortunately, this has been especially true for lower-income communities.”

People living with asthma can avoid unnecessary exposure to OCS by remembering the “Rules of Two” before their next doctor visit. Asthma may be uncontrolled if they’ve:

1. Had more than two courses — or bursts — of OCS in a one-year period
2. Used a quick-relief or rescue inhaler more than two times per week other than before exercise
3. Refilled a quick-relief or rescue inhaler more than two times a year
4. Woke at night with asthma symptoms more than two times per month

OCS Overexposed: Thinking Beyond the Burst is a collaborative, national education campaign to reinforce the importance of appropriate OCS use and reveal OCS overuse for what it often is — a treatment plan failure. Investigate more at www.OCSOverexposed.com.